University of Kentucky College of Medicine; Lexington, Kentucky.
Department of Surgery, Division of Healthcare Outcomes and Optimal Patient Services, University of Kentucky, Lexington, Kentucky.
J Surg Res. 2021 Aug;264:186-193. doi: 10.1016/j.jss.2021.02.011. Epub 2021 Apr 7.
The opioid crisis is a major public health emergency. Current data likely underestimate the full impact on mortality due to limitations in reporting and toxicology screening. We explored the relationship between opioid overdose and firearm-associated emergency department visits (ODED & FAED, respectively).
For the years 2010 to 2017, we analyzed county-level ODED and FAED visits in Kentucky using Office of Health Policy and US Census Bureau data. Firearm death certificate data were analyzed along with high-dose prescriptions from the Kentucky All Schedule Prescription Electronic Reporting records. Socioeconomic variables analyzed included health insurance coverage, race, median household earnings, unemployment rate, and high-school graduation rate.
ODED and FAED visits were correlated (Rho = 0.29, P< 0.01) and both increased over the study period, remarkably so after 2013 (P < 0.001). FAED visits were higher in rural compared to metro counties (P < 0.001), while ODED visits were not. In multivariable analysis, FAED visits were associated with ODED visits (Std. B = 0.24, P= 0.001), high-dose prescriptions (0.21, P = 0.008), rural status (0.19, P = 0.012), percentage white race (-0.28, P = 0.012), and percentage high school graduates (-0.68, P < 0.001). Unemployment and earnings were bivariate correlates with FAED visits (Rho = 0.42, P < 0.001 and -0.32, P < 0.001, respectively) but were not significant in the multivariable model.
In addition to recognized nonfatal consequences of the opioid crisis, firearm violence appears to be a corollary impact, particularly in rural counties. Firearm injury prevention efforts should consider the contribution of opioid use and abuse.
阿片类药物危机是一场重大的公共卫生紧急事件。由于报告和毒理学筛查的限制，目前的数据可能低估了阿片类药物过量对死亡率的全面影响。我们探讨了阿片类药物过量与与枪支相关的急诊就诊（分别为 ODED 和 FAED）之间的关系。
在 2010 年至 2017 年期间，我们使用肯塔基州卫生政策办公室和美国人口普查局的数据，分析了肯塔基州县级 ODED 和 FAED 就诊情况。还分析了枪支死亡证明数据以及肯塔基州所有附表处方电子报告记录中的高剂量处方。分析的社会经济变量包括医疗保险覆盖范围、种族、家庭收入中位数、失业率和高中毕业率。
ODED 和 FAED 就诊情况相关（Rho=0.29，P<0.01），并且在研究期间都有所增加，尤其是在 2013 年之后（P<0.001）。与都会县相比，农村县的 FAED 就诊率更高（P<0.001），而 ODED 就诊率则不然。在多变量分析中，FAED 就诊与 ODED 就诊相关（标准 B=0.24，P=0.001），与高剂量处方相关（0.21，P=0.008），与农村状态相关（0.19，P=0.012），与白种人比例相关（-0.28，P=0.012），与高中毕业率相关（-0.68，P<0.001）。失业率和收入是 FAED 就诊的双变量相关因素（Rho=0.42，P<0.001 和-0.32，P<0.001），但在多变量模型中不显著。
除了阿片类药物危机公认的非致命后果外，枪支暴力似乎是一个附带影响，特别是在农村县。枪支伤害预防工作应考虑阿片类药物使用和滥用的影响。
